tbuckley/cabot-search huggingface dataset:
Abstract 15169: Prediction of Right Ventricular Failure After Left Ventricular Assist Device Implantation: Role of Vasodilator Challenge
Authors: Giulio Cacioli, Vincenzo Polizzi, Michele Ciabatti, Ernesto Cristiano, Amedeo Pergolini, Giada Distefano, Paola Lilla Della Monica, Marina Comisso, Vito Piazza, Fabio Sbaraglia, Francesco Musumeci
Journal: Circulation (2022)

Introduction: pulmonary artery pulsatility index (PAPi) is an indicator of right ventricular (RV) function and an independent predictor of right ventricular failure (RVF) following LVAD implantation. Hypothesis: Administration of vasodilator challenge during right heart catheterization (RHC) could reduce RV workload allowing a better assessment of its functional reserve. Methods: patients undergoing LVAD implantation at our Institution between May 2013 and August 2021 were enrolled. Only patients with RHC and vasodilator challenge with sodium nitroprusside were analyzed. We collected all available clinical, instrumental and haemodynamic parameters, at baseline and after nitroprusside infusion, and we evaluated potential association with post-LVAD RVF. Results: of the 54 patients analyzed, 19 (35%) developed RVF after LVAD implantation. RV FAC (OR 0.647, CI 0.481-0.871; p=0,004), PASP (OR 0.856, CI 0.761-0.964; p=0.010) and post-NTP PAPi (OR 0.218, CI 0.073-0.653; p=0.006) were independent predictors of post-LVAD RVF. The model combining RV FAC, PASP and post-NTP PAPi presented a predictive accuracy of 90.7%. Addition of post-NTP PAPi led to increased EUROMACS-RHF risk score (79.4% vs 70.4%; AUC 0.841 vs 0.724, p=0.022) and CRITT score (79.6% vs 74%; AUC 0.861 vs 0.767, p=0.033) predictive accuracy. Conclusions: post-NTP PAPi has proven to be an independent predictor of RVF following LVAD implantation. Dynamic assessment of PAPi through vasodilator challenge could represent a test of RV functional reserve in candidates for LVAD implantation. Larger and prospective studies are needed in order to confirm this hypothesis.
Abstract 15128: Are We Underestimating the Incidence of Significant Ventricular Ectopy in Pediatric Patients With Post-Covid Vaccine Myocarditis?
Authors: Erica L Del Grippo, Sean Connolly, Elaine Geary, Joel Temple, Deepika Thacker
Journal: Circulation (2022)

Background: The development of mRNA vaccines was essential in combatting the COVID-19 pandemic. Emergency use authorization for COVID-19 vaccine was granted to adolescents aged 12 and older in May 2021. Subsequently, an increase in myocarditis was observed related to the mRNA vaccine. Previous reports estimate a 5% incidence of ventricular arrhythmias in patients with vaccine-associated myocarditis. Hypothesis: The incidence of ventricular ectopy in patients with post-COVID vaccine myocarditis is higher than previously described. Methods: We analyzed data retrospectively for patients admitted to our cardiac center with clinically suspected myocarditis who received COVID-19 vaccine within 30-days prior to onset of symptoms and had no other clinical cause for myocarditis. We separated this cohort into 3 groups based on the presence of rhythm monitoring post discharge: normal monitor post discharge (Lown grade 0 or 1), abnormal monitor post discharge (Lown grade ≥ 2), and no monitor post discharge. Data are shown as mean ± standard deviation. Results: We included 16 patients with a mean age of 14.9 ± 3.1 years. 12 patients were discharged with ambulatory monitoring and 3 were categorized as abnormal (25%). Abnormal findings included non-sustained ventricular tachycardia, ventricular ectopy with bigeminy and trigeminy patterns, and sustained monomorphic ventricular tachycardia. 1 patient was readmitted for sustained ventricular tachycardia. Mean troponin levels were higher in the arrhythmia group (17.3 ±4) compared to the non-arrhythmia group (4.3 ±4.3). 2 of the 3 patients in the arrhythmia group had myocardial edema on cMRI. Only one patient had LGE. Conclusion: At our center, 25% of patients with post-COVID vaccine myocarditis experienced ventricular arrhythmias, and these patients had higher troponin levels during acute illness. Awareness of this increased rate of arrhythmia is necessary to safely monitor patients with post-COVID vaccine myocarditis.
Abstract 15179: Histology-Validated Delayed Enhancement Magnetic Resonance Imaging of Atrial Fibrillation Driver Substrate
Authors: Uma Mylavarapu, Benjamin Buck, Megan Subr, Lisa Hoenie, Anuradha Kalyanasundaram, Yue Pan, James Kennelly, Ning LI, Brian Hansen, Jichao Zhao, Orlando Simonetti, John Hummel, Vadim V Fedorov
Journal: Circulation (2022)

Introduction: Persistent (per) AF may be maintained by localized extra-PV drivers (DRs). Regional fibrosis can serve as a substrate for AF DRs, but its visualization by delayed enhancement (DE)-MRI lacks proper validation for driver substrates. The objective of this study is to evaluate if histology-validated normalized (HVN) DE-MRI thresholds can define arrhythmogenic fibrotic content in multielectrode mapping (MEM)-defined DRs from perAF patients’ (Pts) DE-MRI. Methods: PerAF Pts (n=14, 71% male; 63±10 y/o) had DE-MRI at 3T (0.63x0.63x0.63mm 3 , 0.2mmol/kg Gd) before their perAF ablation procedure. Chamber-specific DE-MRI intensity was normalized to the healthy atria (mean lowest 5% intensity, 0 AU) and mitral (LA) or tricuspid (RA) valve (100 AU). 3 control and 5 perAF canines had DE-MRI and regional histology to validate DE-MRI fibrotic thresholds for the LA and RA, which were defined as standard deviations (SD) above 40% of the mean healthy atrial tissue intensity (LA: 3.7 SD, RA: 2.7 SD). Fibrosis-enhancement of segmented MEM-defined DRs (LA: n=25, RA: n=11) were analyzed using conventional, non-normalized 3 SD and HVN thresholds and compared to 5 random regions (non-DRs) within the same anatomical region(s). Results: Only our HVN approach could reveal arrhythmogenic fibrotic substrates in LA DR regions, but not the conventional approach. Both approaches could not provide significant differences for RA DR vs non-DR fibrosis regions. The cut-off of 33.6% of LA DE-MRI fibrotic enhancement using the HVN approach allowed to distinguish LA DR vs. non-DR regions with 56% sensitivity and 70% specificity. At 12 months follow-up, 10 Pts remained free of AF. Conclusion: MEM-defined DRs within fibrotic regions, identified by HVN DE-MRI, may represent efficient targets for ablation of LA arrhythmogenic perAF substrates. Integration of MEM and MRI may lead to improved targeted ablation and long-term AF freedom.
Abstract 15124: Impact of Stable Coronary Artery Disease on In-Hospital Outcomes and Readmissions Following Catheter Ablation for Atrial Fibrillation
Authors: Mohan Satish, Ryan Walters, Venkata Alla, Jonathan L Halperin
Journal: Circulation (2022)

Introduction: Outcomes within coronary artery disease (CAD) patients after catheter ablation (CA) for atrial fibrillation (AF) remain unclear. In this study, we assessed the impact of stable CAD on 90-day readmission rates following hospitalization for CA of AF. Methods: Using the Nationwide Readmissions Database (NRD), we identified all hospitalizations from the fourth quarter of 2015 to 2019 with a Medicare Severity-Diagnosis Related Group for a percutaneous intracardiac procedure, a procedure code for CA, and a primary discharge diagnosis of AF. Presence of acute coronary syndrome (ACS) at index hospitalization was excluded to define stable CAD and stratify by its presence. Our primary outcome was all-cause 90-day readmission; secondary outcomes included readmission for AF, repeat CA, ACS, and heart failure (HF). We controlled for selection bias using inverse probability of treatment weights (IPTW) and targeted the average treatment effect. Results: An estimated 28,466 hospitalizations for CA for AF were identified, of which 3,171 (11.1%) had concomitant stable CAD. Of note, no index hospitalization included a HF diagnosis, regardless of stable CAD. The 90-day all-cause readmission rate was significantly higher in patients with stable CAD compared to those without stable CAD (18.4% vs. 14.4%, p = .006; Fig. 1) with a significantly higher burden of new ACS (5.3% vs. 1.1%, p &lt; .001) and new HF (17.0% vs. 10.2%, p = .007). AF recurrence rates as 90-day readmission did not differ statistically (21.9% vs. 26.5%, p = .217). Further pooled analysis of all 90-day HF readmissions revealed a significantly higher burden of older patients, with underlying chronic kidney or pulmonary disease, and persistent and chronic AF subtypes. Conclusions: Our large-scale analysis suggests that in patients hospitalized for CA for AF, stable CAD is a marker for adverse prognosis and is associated with a higher 90-day readmission rate and significant burden of new ACS and new HF.
Abstract 15104: Diverse Associations Between Long-Term Body Mass Index Variability and Midlife Cognitive Function: The Bogalusa Heart Study
Authors: Soo Jung Kang, Ileana De Anda-Duran, Camilo A Fernandez, Lydia A Bazzano
Journal: Circulation (2022)

Introduction: Evidence shows that individual variation of body weight over time may have a role in explaining cognitive decline later in life independent from obesity status. Yet, the effect of long-term variability from childhood on midlife cognitive function (CF), as well as race differences remains unclear. This study examines this association among Black and White middle-aged individuals from a community cohort in Bogalusa, Louisiana. Methods: A total of 1,268 participants (59.5% women, 34.4% Black) from the Bogalusa Heart Study who had &gt; 4 BMI measurements from childhood (mean age: 9.5 ± 3.5), and complete neuropsychological (NP) tests assessment to evaluate CF at midlife (48.2 ± 5.2) were studied. CF was measured with a global cognitive score (GCS). Long-term BMI variability was computed as standard deviation (SD), coefficient of variation (CV), deviation from age-predicted values (DEV), and residual SD (RSD). Regression models were used to evaluate the associations between BMI variability and GCS. Covariates included age, sex, race, cardiovascular risk factors, depression, class II obesity (BMI ≥ 35kg/m 2 ) at midlife, alcohol use, education and employment status. Race, sex and BMI variability interactions were evaluated. Results: Overall, higher DEV and RSD [Beta (SE): -0.30 (0.10); p = 0.003, and – 0.17 (0.08); p = 0.025, respectively] was associated with lower GCS. Interactions between SD, CV, DEV, and RSD with race were significant, but not with sex. Stratified analyses of the relationship between BMI variability measures and GCS showed the following result among White participants [DEV Beta (SE): -0.25 (0.10); p = 0.01] and Black participants [DEV Beta (SE): -0.03 (0.13); p = 0.81], respectively. Conclusion: We identified diverse associations between BMI variability from childhood and cognitive function in midlife. Although Black participants appear more resilient to the influence of BMI variability on CF in midlife, further studies are needed to identify the nature of this complex phenomenon and its potential to contribute to vascular causes of cognitive decline and dementia.
Abstract 15076: Decisional Regret in Patients Undergoing Transcatheter Aortic Valve Replacement Procedure
Authors: Amrit kanwar, George Jolly, Saif Ali, Michael T Kashner, Helme Silvet
Journal: Circulation (2022)

Introduction: Decisional regret has been associated with reduced quality of life and lower satisfaction with care and is an important patient-reported outcome, which has not been studied in patients undergoing TAVR (transcatheter aortic valve replacement) procedure. In our study, we used a simple Decision Regret Scale to evaluate decisional regret in veterans and their family members after TAVR. Methods: Demographic, clinical characteristics, death outcomes and results of Decision Regret scale administered to patients and/or family member were recorded for all subsequent subjects referred for TAVR by a single VA medical center between October 2013 and September 2020. Data were analyzed using Cox regressions. Results: Study included 124 patients (Table 1) who were followed from the TAVR date until censored date or death for a mean of 939 days (range 3-2,487 days). During this time, 67 patients (54%) died, with comorbidities predicting death (Charlson’s comorbidity index by Cox multivariable regression, p=0.002). Using a mean regret scale with 0 being no regret and 100 being overwhelming regret, patients had a mean regret scale of 7.95 ± 11, whereas family had a mean regret scale of 20.36 ± 31 (most family responders were in patients who had already died). By exploratory analysis, decisional regret was not associated with higher likelihood of predicted death (patient responders, p= 0.6; family responders p=0.2). Patients were more likely to report that decision for the procedure was a joint decision with the physician (55% patient vs 36% family responders), whereas family was more likely to report that patient alone had made the decision. Conclusions: After initial adoption, TAVR procedure in veteran patients was associated with high mortality, primarily due to existing comorbidities. Surviving patients themselves had a low level of decisional regret regarding TAVR compared to moderate regret expressed by family members, mostly reported after patients had died.
Abstract 14955: The Biological Bases of Psychosocial Stress-Associated Cardiovascular Disease: Investigating the Cardioprotective Properties of Central Arginine-Vasopressin
Authors: Mario Gil, Fernando Dominguez, Esperanza I Alaniz, Alexandra Chalons, John L VandeBerg
Journal: Circulation (2022)

Psychosocial stressors (e.g., anxiety, personality traits, social isolation) are risk factors for cardiovascular events and heart disease. However, there is a lack of knowledge regarding the biological mechanisms that underlie this risk-outcome relationship. To address this knowledge gap, our team uses two non-traditional animal models, the Syrian hamster ( Mesocricetus auratus ) and gray short-tailed opossum ( Monodelphis domestica ). We previously reported that social isolation-induced aggression, a type of psychosocial stress experience, leads to increased neural activation in the ventral tegmental area (VTA) of the midbrain. The VTA contains tyrosine hydroxylase (TH)-producing (putative dopamine, DA) neurons and is innervated by vasopressin (AVP) fibers. DA and AVP play a role in social behavior, and we investigated whether these two systems interact when an individual experiences psychosocial stress-induced aggression. Here we report that social interactions increased Fos, the protein product of the immediate early gene c-fos that serves as a marker of neuronal activation, in non-TH cells in an area of the VTA called the interfascicular nucleus (IF) of male subjects. Previous social experience increased the number of TH-positive cells in the IF but had no effect on the number of AVP-ir fibers. Conversely, levels of aggressive and social dominance behaviors were positively correlated with the number of AVP-ir fibers in the IF, whereas there was no relationship between these behaviors and the number of TH-positive cells. In socially naïve males, AVP microinjected into the VTA inhibited the duration of aggressive behavior. We are currently investigating the impact of our psychosocial stress paradigms on myocardial injury in both males and females. Our results suggest a complex interaction between AVP and DA systems in the brain in psychosocial stress responses. Our long-term goal is to build on these preliminary findings to determine whether AVP in the VTA may reduce psychosocial stress-induced myocardial injury, a first step in exploring heart-brain interactions that may link psychosocial stress with negative cardiovascular disease outcomes.
Abstract 15080: Higher Mortality Risk in Very Severe Aortic Stenosis Associated With Atrial Fibrillation
Authors: Hossam H Ibrahim, Jeremy J Thaden, Katarina L Fabre, Christopher G Scott, Sorin Pislaru, Vuyisile T Nkomo
Journal: Circulation (2022)

Background: Atrial fibrillation (AF) in severe aortic stenosis (AS) is associated with worse outcomes compared to sinus rhythm (SR). The prevalence of AF and its impact on outcomes in very severe AS (vsAS) is unknown. Objectives: To determine the prevalence and prognostic significance of AF in vsAS. Methods: A total of 563 patients with vsAS (transaortic valve peak velocity ≥5 m/sec) were identified retrospectively out of 3139 with aortic valve area ≤1.0 cm 2 or ≤0.6 cm 2 /m 2 and left ventricular ejection fraction (LVEF) ≥50%. Patients were divided by rhythm (AF vs SR) at the time of index transthoracic echocardiogram. Outcomes in AF versus SR were compared in propensity-matched analyses (2 SR:1 AF). Results: AF was present in 50/563 patients (9%) and SR in 513/563 (91%). In propensity-matched analyses (100 SR:50 AF), the mean age was 83.2±7.3 years, 54% were female. There was no difference in comorbidity index (p=0.84). There was no difference in AF compared to SR in aortic valve area (0.7±0.1 vs 0.7±0.1 cm 2 , p=0.94), peak velocity (5.3±0.3 vs 5.3±0.3 m/sec, p=0.32), LVEF (63±7 vs 65±7%, p=0.14) or E/e’ (23±13 vs 21±12, p=0.48), but patients with AF had larger left atrial volume index (60±16 vs 48±15 mL/m 2 , p&lt;0.001), higher right ventricular systolic pressure (52±15 vs 41±16 mmHg, p&lt;0.001), and higher prevalence of moderate or more tricuspid regurgitation (33% vs 5%, p&lt;0.001) and right ventricular systolic dysfunction (23% vs 6%, p=0.003). Age-, sex-, comorbidity index-adjusted all-cause mortality was higher in AF vs SR (HR 2.33 [1.40, 3.87], p=0.001) ( Figure: Observed overall survival ). Aortic valve replacement (AVR) was associated with improved survival (HR 0.44 [0.25, 0.76], p=0.004) with no evidence of interaction of AVR and rhythm (p=0.15). Conclusion: AF was not uncommon among patients with vsAS and identified a subset of patients with vsAS at much higher risk of mortality. Whether AVR should be considered earlier in vsAS when associated with AF needs to be investigated.
Abstract 15113: C-cbl E3 Ubiquitin Ligase Regulates Cardiomyocyte Proliferation and Cardiac Regeneration
Authors: Qui A Le, Xinji Guo, Mikhail A Kolpakov, Mallory Turner, Meriem Bkhache, Khadija Rafiq, Binbin Du, Sankar Addya, Tao Wang, Abdelkarim Sabri
Journal: Circulation (2022)

Background: Neonatal mammalian hearts display considerable regenerative capacity following injury through cardiomyocyte proliferation. However, this regenerative capacity is lost by post-natal day 7. Previous studies have shown the role of receptor tyrosine kinases (RTKs) on cardiomyocyte proliferation and cardiac regeneration. However, the mechanisms that control RTK turnover and signaling during and beyond the regenerative window of the heart remain largely unknown. Hypothesis: This study investigates the role of the proto-oncogene Casitas b-lineage lymphoma (c-Cbl), an adaptor protein with an intrinsic E3 ubiquitin ligase activity that targets RTKs, on cardiomyocyte proliferation and cardiac regeneration following myocardial infarction (MI). Methods and Results: c-Cbl expression was downregulated during post-natal development and re-expressed in the adult heart following MI. RNA-sequencing studies reveal a distinct transcriptional profile in c-Cbl-deficient mouse hearts, of which c-Cbl deletion substantially delayed cardiomyocyte maturation and enhanced cardiomyocyte proliferation. c-Cbl deletion also extended the regenerative window for post-natal mouse hearts following MI and enhanced the ability to recover following MI with improved myocardial function, reduced scar formation, and increased cardiomyocyte cell-cycle activity. Mechanistically, c-Cbl E3 ubiquitin ligase activity was markedly enhanced in the adult than neonatal heart following MI, along with increased ubiquitination and downregulation of key RTKs involved in cardiomyocyte proliferation. Intriguingly, adenoviral expression of a c-Cbl mutant deficient in E3 ligase enhanced RTK signaling and promoted cardiomyocyte proliferation in vitro. Conclusions: These results reveal c-Cbl as a critical regulator of cardiomyocyte proliferation and a potential therapeutic target for the maintenance of cardiac regeneration and function following MI.
Abstract 15162: Anomalous Right Coronary Artery From the Left Sinus of Valsalva With an Interarterial Course: Impact on Clinical Outcomes in the Adult Population
Authors: Eric Warner, Aishwarya Gulati, Ethan Halpern, David L Fischman, Nicholas J Ruggiero, Scott W Keith, Melissa McCarey, Michael P Savage
Journal: Circulation (2022)

Introduction: Anomalous right coronary arteries (RCA) arising from the left sinus of Valsalva with an interarterial course (lAC) may cause sudden cardiac death in children and adolescents. However, the natural history and management of patients in whom this anomaly is first detected during adulthood remains uncertain. Methods: Database review identified patients ≥35 years old with anomalous coronary arteries diagnosed by cardiac catheterization or coronary computed tomographic angiography. The outcomes of patients with anomalous RCA with IAC treated conservatively were compared to patients with anomalous left circumflex (LCX) coronary arteries with retroaortic course (an anomaly not associated with ischemic events). The primary outcome was all-cause mortality. Secondary outcomes included survived cardiac arrest and myocardial infarction. Results: The study population consisted of 185 patients (115 men, 70 women) aged 59 ± 12. Clinical characteristics were similar in the RCA (n=88) and LCX (n=97) groups. At follow-up of 6.6 ± 4.4 years there were no statistically significant differences between the 2 groups in mortality (p=0.11) or in secondary outcomes (P=0.89). Conclusions: The outcome of adult patients who had an anomalous RCA with lAC were similar to patients who had anomalous LCX with a known benign course. These results suggest that most patients who survive this anomaly into adulthood may be managed conservatively without intervention.